Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction

The objective of the study was to identify the population of patients with neck pain who improved with home-based mechanical cervical traction (HMCT). A prospective cohort study was conducted in a physical therapy clinic at a local hospital. Patients with neck pain referred to the clinic for physical therapy were included in the study. A HMCT program was given to participants for 2 weeks. The patient’s demographic data, Numerical Pain Scale (NPS) score, Neck Disability Index (NDI) and Fear-Avoidance Beliefs Questionnaire score were collected, and standard physical examination of the cervical spine was conducted before intervention. The NPS score, NDI and a global rating of perceived improvement were collected after the intervention was completed. A total of 103 patients participated in the study and 47 had a positive response to HMCT. A clinical prediction rule with four variables (Fear-Avoidance Beliefs Work Subscale score < 13, pre-intervention pain intensity ≥ 7/10, positive cervical distraction test and pain below shoulder) was identified. With satisfaction of at least three out of four variables (positive likelihood ratio = 4.77), the intervention’s success rate increased from 45.6% to over 80%. It appears that patients with neck pain who are likely to respond to HMCT may be identified.     

颈椎病病人颈部疼痛的影响因素分析

目的探讨引起颈椎病病人颈部疼痛的影响因素,尤其是Modic改变在颈部疼痛中所起的作用。方法回顾分析2016年9月至2019年4月于我院就诊的261例颈椎病病人,其中男136例,女125例,年龄为(51.2±10.9)岁。纳入统计的因素包括年龄、性别、身体质量指数(body mass index,BMI)、吸烟史、受教育水平、颈椎曲度改变、颈椎滑脱、Modic改变、高级别椎间盘退变、椎间盘高度丢失和纤维环撕裂。通过数字化疼痛量表(numerical rating scale,NRS)评估病人的颈部疼痛程度,利用单因素分析及多因素Logistic回归分析分别计算上述因素对严重性颈部疼痛(SNP)和持续性颈部疼痛(PNP)的影响。另外,利用单因素分析及多因素Logistic回归分析计算颈椎滑脱、椎间盘退变分级、椎间盘高度丢失和纤维环撕裂对Modic改变的影响。结果共32例存在Modic改变。1型Modic改变病人的NRS评分明显高于2型(4.6±0.7 vs.3.7±1.1,P=0.003)。多因素Logistic回归分析显示颈椎后凸[OR=2.413,95%CI(1.329,5.180),P=0.009]、颈椎滑脱[OR=2.962,95%CI(1.592,5.665),P=0.001]和纤维环撕裂[OR=1.766,95%CI(1.087,2.765),P=0.021]是病人SNP的3个独立危险因素,而颈椎后凸[OR=2.738,95%CI(1.399,5.468),P=0.005]、颈椎滑脱[OR=2.565,95%CI(1.361,4.784),P=0.006]和Modic改变[OR=2.360,95%CI(1.264,4.275),P=0.010]是病人PNP的3个独立危险因素。Modic改变与椎间盘病变的回归分析提示高级别椎间盘退变[OR=2.512,95%CI(1.186,5.611),P=0.013]以及椎间盘高度丢失[OR=2.403,95%CI(1.160,5.721),P=0.025]是Modic改变的独立危险因素。结论颈椎后凸、颈椎滑脱和纤维环撕裂会加重颈椎病病人颈部疼痛的程度,而颈椎后凸、颈椎滑脱和Modic改变会延长颈椎病病人颈部疼痛的时间。此外,高级别椎间盘退变和椎间盘高度丢失是颈椎Modic改变的危险因素。     

A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with mechanical lumbar traction

The objective of the study was to develop a clinical prediction rule for identifying patients with low back pain, who improved with mechanical lumbar traction. A prospective, cohort study was conducted in a physiotherapy clinic at a local hospital. Patients with low back pain, referred to physiotherapy were included in the study. The intervention was a standardized mechanical lumbar traction program, which comprised three sessions provided within 9 days. Patient demographic information, standard physical examination, numeric pain scale, fear-avoidance beliefs questionnaire and Oswestry low back pain disability index (pre- and post-intervention) were recorded. A total of 129 patients participated in the study and 25 had positive response to the mechanical lumbar traction. A clinical prediction rule with four variables (non-involvement of manual work, low level fear-avoidance beliefs, no neurological deficit and age above 30 years) was identified. The presence of all four variables (positive likelihood ratio = 9.36) increased the probability of response rate with mechanical lumbar traction from 19.4 to 69.2%. It appears that patients with low back pain who were likely to respond to mechanical lumbar traction may be identified.     

Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain

Purpose

Objective of this study is to evaluate the diagnostic values of the Arm Squeeze Test. The test consists in squeezing the middle third of the upper arm.

Methods

1,567 patients were included in this study. Diagnosis of cervical nerve root compression or shoulder disease was clinically formulated and confirmed with imaging before performing test. 350 healthy volunteers were recruited as controls. The test was positive when score on a VAS Scale was 3 points or higher on squeezing the middle third of the upper arm compared to acromioclavicular (AC) joint and anterolateral-subacromial area.

Results

Patients were subdivided as follows: 903 with rotator cuff tear, 155 with shoulder adhesive capsulitis, 101 with AC joint arthropathy, 55 with calcifying tendonitis, and 48 affected by glenohumeral arthritis. The study sample included 305 patients with cervical nerve root compression from C5 to T1 with shoulder radicular pain. The test was positive in 295/305 (96.7 %) of patients with cervical nerve root compression, compared to 35/903 (3.87 %), 3/155 (1.93 %), 0/101 (0 %), 1/55 (1.81 %) and 4/48 (8.33 %) of those with rotator cuff tear, adhesive capsulitis, AC arthropathy, calcifying tendonitis and glenohumeral arthritis, respectively. A positive result was obtained in 14/350 asymptomatic subjects (4 %). If patients with cervical nerve root compression were compared to controls and patients with shoulder diseases, the test had sensitivity of 0.96 and specificity from 0.91 to 1.

Conclusions

The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain.     

青少年颈痛患者颈椎失稳特点与生活习惯的相关性分析

目的:探讨青少年颈痛患者的颈椎失稳与生活习惯之间的关系。方法:收集青少年颈痛患者59例(颈痛组)及健康青少年17例(对照组)的基本信息和生活习惯,拍摄颈椎侧位及动力位X线片,分析颈椎失稳特点及颈椎失稳与生活习惯的相关性。结果:两组患者的年龄、身高、体重、体重指数基线资料比较差异均无统计学意义。生活习惯比较,颈痛组平均每天使用手机时间多于对照组,而对照组每天运动时间多于颈痛组。颈椎失稳测量结果,颈痛组失稳发生率大于对照组;在过屈位时,颈痛组在C_3-C_4,C_4-C_5,C_5-C_6之间的椎体角位移大于对照组;颈痛组自身C_4-C_5段过屈位角位移大于过伸位,C_6-C_7段过伸位角位移大于过屈位。颈痛组生活习惯与颈椎失稳的相关分析,C_4-C_5角位移值在过伸位与使用手机时间呈正相关(r=0.275,P=0.035),过屈位与使用手机时间呈显著正相关(r=0.577,P0.001),与每天运动时间呈负相关(r=-0.279,P=0.032)。C_5-C_6角位移在过屈位与每天运动时间呈负相关(r=-0.292,P=0.025),在过伸位角位移与每天使用电脑时间呈负相关(r=-0.262,P=0.045)。结论:青少年颈痛患者每天使用手机时间多于正常青少年,而运动时间少于正常青少年,且颈椎失稳出现率较高,以C_3-C_4,C_4-C_5,C_5-C_6节段为主。每天运动时间越长,C_4-C_5,C_5-C_6角位移测量值就越小;每天使用手机时间越长,C_4-C_5角位移测量值就越大。     

颈部疼痛程度与颈椎曲度相关性的临床观察

目的:探讨颈部疼痛程度与颈椎曲度的相关性。方法:2009年6月～2011年4月在我院颈椎专家门诊就诊的颈部疼痛患者121例,男性56例,女性65例,年龄17～79岁,平均51.2±17.7岁。对所有患者的颈痛程度进行数字分级法(numeric rating scales,NRS)评分,根据中立位颈椎X线侧位片的颈椎曲度(颈椎角)分为4组,即前凸组、曲度变直组、反屈组和S型组,比较各组之间颈痛程度,并对颈痛程度与颈椎曲度进行相关性分析。结果:121患者中颈椎前凸37例,曲度变直26例,反屈31例,S型27例,其NRS评分分别为4.81±1.90分,5.63±3.64分,5.15±2.47分,6.81±4.65分,颈椎曲度变直组和曲度S型组患者的颈痛程度NRS评分与颈椎前凸组相比差异有显著性(P<0.05),其余各组间两两比较差异无显著性(P>0.05)。患者颈痛程度与颈椎角成弱负相关(r=-0.218,P=0.039)。结论:颈部疼痛程度与颈椎曲度有关,颈痛程度与颈椎角成弱负相关,在治疗颈椎疾患时应注意对颈椎曲度的矫正。     

The association between cervical spine curvature and neck pain

Degenerative changes of the cervical spine are commonly accompanied by a reduction or loss of the segmental or global lordosis, and are often considered to be a cause of neck pain. Nonetheless, such changes may also remain clinically silent. The aim of this study was to examine the correlation between the presence of neck pain and alterations of the normal cervical lordosis in people aged over 45 years. One hundred and seven volunteers, who were otherwise undergoing treatment for lower extremity problems in our hospital, took part. Sagittal radiographs of the cervical spine were taken and a questionnaire was completed, enquiring about neck pain and disability in the last 12 months. Based on the latter, subjects were divided into a group with neck pain (N = 54) and a group without neck pain (N = 53). The global curvature of the cervical spine (C2–C7) and each segmental angle were measured from the radiographs, using the posterior tangent method, and examined in relation to neck complaints. No significant difference between the two groups could be found in relation to the global curvature, the segmental angles, or the incidence of straight-spine or kyphotic deformity (P > 0.05). Twenty-three per cent of the people with neck pain and 17% of those without neck pain showed a segmental kyphosis deformity of more than 4° in at least one segment—most frequently at C4/5, closely followed by C5/6 and C3/4. The average segmental angle at the kyphotic level was 6.5° in the pain group and 6.3° in the group without pain, with a range of 5–10° in each group. In the group with neck pain, there was no association between any of the clinical characteristics (duration, frequency, intensity of pain; radiating pain; sensory/motor disturbances; disability; healthcare utilisation) and either global cervical curvature or segmental angles. The presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain. This should be given due consideration in the differential diagnosis of patients with neck pain.     

铍针治疗颈椎病性颈痛61例临床观察

颈椎痫为临床上多发病、常见病，而颈部疼痛是颈椎病最常见的症状之一，在各型颈椎病中均可出现。自2006年7月至2007年6月运用铍针治疗颈椎病性颈痛61例，疗效满意，报告如下。     

Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial

Background Context

A previous study demonstrated that in seniors, the presence of cervical musculoskeletal impairment was not specific to cervicogenic headache but was present in various recurrent headache types. Physiotherapy treatment is indicated in those seniors diagnosed with cervicogenic headache but could also be adjunct treatment for those with cervical musculoskeletal signs who are suspected of having transitional headaches.

Neck pain and disability due to neck pain: what is the relation?

Pain and disability are interrelated, but the relationship between pain and disability is not straightforward. The objective of this study was to investigate the relationship between neck pain (NP) intensity, NP duration, and disability based on the population-based ‘Funen Neck and Chest Pain’ study. Pain intensity was measured using 11-box numerical rating scales, pain duration was measured using the Standardized Nordic Questionnaire, and disability was measured by the Copenhagen Neck Functional Disability Scale. Spearman rank correlation coefficients and logistic regression analyses were used to measure correlations and strength of associations between pain intensity, pain duration, and disability given domain specific characteristics (socioeconomic, health and physical, comorbidity, and variables related to consequences of NP). Neck pain was very common, but mainly mild and did not result in major disability. The correlations between NP intensity and disability were moderate but strongly associated, whereas weaker correlations and almost no associations were found between NP duration and disability. Pain duration is a poor indicator of disability. Given these variations, pain intensity and disability should be considered as two distinct dimensions and measured separately. These results have implications for future clinical and epidemiological studies.     

Cervical range of motion and strength in 4,293 young male adults with chronic neck pain

Purpose

The correlation of cervical biomechanics and neck pain in young patients has, to date, only been described in terms of small cohorts. This study focuses on the correlation of chronic neck pain and cervical biomechanics.

Methods

Neck pain, cervical range of motion (CROM) and maximal cervical torque were recorded in 746 patients with conservatively treated chronic neck pain and 3,547 participants of physiotherapy training without chronic neck pain aged 16–32 years.

Results

The “neck pain” group had a highly significant (s < 0.001) higher neck disability index (44.7 vs. 10.4 %), longer history of neck pain (3.47 vs. 0.59 years), higher pain intensity (VAS 5.93 vs. 0.93), higher pain frequency (VAS 6.98 vs. 1.09). No differences of CROM and maximal torque in the sagittal, frontal and transverse plane were found.

Conclusion

This study describes the largest cohort of biomechanical data of the cervical spine in young adult recorded to date. The findings demonstrate that no correlation was found between neck pain, CROM and maximal torque in the study cohort. On this basis, we conclude that the CROM and maximal cervical torque should not be used as indicators to measure the progress of chronic neck pain in physiotherapy training and sports medicine for the young adult.     

Spinal manipulative therapy and exercise for seniors with chronic neck pain

Background contextNeck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy (SMT) and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in seniors.PurposeTo assess the relative effectiveness of SMT and supervised rehabilitative exercise, both in combination with and compared to home exercise (HE) alone for neck pain in individuals ages 65 years or older.Study design/settingRandomized clinical trial.Patient sampleIndividuals 65 years of age or older with a primary complaint of mechanical neck pain, rated ≥3 (0–10) for 12 weeks or longer in duration.Outcome measuresPatient self-report outcomes were collected at baseline and 4, 12, 26, and 52 weeks after randomization. The primary outcome was pain, measured by an 11-box numerical rating scale. Secondary outcomes included disability (Neck Disability Index), general health status (Medical Outcomes Study Short Form-36), satisfaction (7-point scale), improvement (9-point scale), and medication use (days per week).MethodsThis study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Linear mixed model analyses were used for comparisons at individual time points and for short- and long-term analyses. Blinded evaluations of objective outcomes were performed at baseline and 12 weeks. Adverse event data were collected at each treatment visit.ResultsA total of 241 participants were randomized, with 95% reporting primary outcome data at all time points. After 12 weeks of treatment, the SMT with home exercise group demonstrated a 10% greater decrease in pain compared with the HE-alone group, and 5% change over supervised plus home exercise. A decrease in pain favoring supervised plus HE over HE alone did not reach statistical significance. Compared with the HE group, both combination groups reported greater improvement at week 12 and more satisfaction at all time points. Multivariate longitudinal analysis incorporating primary and secondary patient-rated outcomes showed that the SMT with HE group was superior to the HE-alone group in both the short- and long-term. No serious adverse events were observed as a result of the study treatments.ConclusionsSMT with HE resulted in greater pain reduction after 12 weeks of treatment compared with both supervised plus HE and HE alone. Supervised exercise sessions added little benefit to the HE-alone program.     

Factors affecting the timing of recovery from whiplash neck injuries: study of a cohort of 134 patients pursuing litigation

Introduction A cohort of 134 patients presenting in medico-legal practice with whiplash neck injury following a motor vehicle accident was studied prospectively by personal interviewing. Materials and methods Injury- and patient-related factors with possible influence to the timing of recovery were analysed with univariate and multivariate statistical methods. Results Logistic regression showed significant association between high physical demand patient occupation and recovery within 6 months from injury (P = 0.036, coefficient 1.5, odds ratio 4.47) while initiation of physiotherapy treatment was associated with prolongation of symptoms for more than 6 months following injury (P < 0.001, coefficient −2.6, odds ratio 0.08). An association between development of arm pain (P = 0.01), upper limb numbness or paraesthesia (P = 0.03) and bilateral trapezius pain (P = 0.04) and persistence of whiplash-related symptoms was also observed. These findings must be taken into account in evaluation and treatment of patients with acute whiplash injuries pursuing litigation.     

Atlantoaxial instability in a patient with neck pain and rheumatoid arthritis

Context: The purpose of this report is to describe the clinical decision-making process for a patient with rheumatoid arthritis with neck pain with underlying atlantoaxial instability.Findings: The patient was evaluated for worsening upper neck pain that began insidiously 1 year prior. The patient denied numbness or tingling in her upper or lower extremities, dizziness or lightheadedness, difficulty maintaining balance with walking, or muscle weakness. Cervical spine range of motion was limited in all planes due to pain and apprehension. The patient’s neurological examination was unremarkable. Prior flexion and extension radiographs of the cervical spine were interpreted as unremarkable with alignment preserved in flexion and extension. However, upon further inspection, the cervical spine flexion radiograph was concerning for inadequate cervical motion, which may have limited the diagnostic utility of these radiographs. Additionally, a Sharp-Purser test was performed, which was positive for excessive motion. Flexion and extension radiographs of the cervical spine were then repeated ensuring the patient adequately flexed and extended during the imaging. Severe anterior subluxation of C1 relative to C2 with cervical flexion was noted, as C1 moved as much as 8–9 mm anterior to C2 with cervical flexion. Given the degree of atlantoaxial instability, the patient subsequently underwent successful posterior fusion from the occiput to C2.Conclusion/Clinical Relevance: This case report demonstrates the importance of properly screening for upper cervical spine instability in patients with rheumatoid arthritis and neck pain and understanding the importance of obtaining adequate and appropriate diagnostic imaging.     

Insidious onset neck pain - a symptom not to be dismissed

Chronic neck pain is an extremely common symptom in the general population. Most cases have underlying musculoskeletal aetiologies and are managed conservatively. However, a very small number of patients presenting with chronic neck pain will have significant underlying pathology, e. g. a spinal cord tumour. Intramedullary spinal cord tumours are uncommon at all ages, particularly in adults, and there are some controversies in their treatment. The case of an 18-year-old man with chronic neck pain who was subsequently shown to have a pilocytic intramedullary astrocytoma is presented. This report highlights the need to consider rare, but potentially serious, diagnoses in individuals presenting with non-resolving, but seemingly innocent, symptoms over a prolonged period.     

在甲状腺乳头状癌中施行保留颈丛的改良颈清扫术

目的探讨保留颈丛的功能性颈清扫术在分化性甲状腺癌手术中的临床应用。方法回顾性分析18例施行保留颈丛的改良性颈淋巴结清扫的甲状腺乳头状癌患者的临床资料,选取同期的甲状腺癌颈淋巴结转移行不保留颈丛的改良性清扫的患者20例,观察并比较两组术后出现相应颈丛损伤的功能障碍发生率。结果保留颈丛者出现局部麻木者耳垂区22．2％（4／18）、颈部16．7％（3／18）、锁骨区16．7％（3／18）,不保留颈丛组出现局部麻木者耳垂区100．0％（20／20）、颈部55．0％（11／20）、锁骨区55．0％（11／20）。前者功能障碍的发生率明显低于后者（P〈O．05）。结论保留颈丛的改良性颈清扫术在甲状腺乳头状癌手术中不会增加淋巴结转移率．有效地保留了耳垂区、颈部、锁骨区的感觉,提高了患者的生存质量。     

前路不同手术方式治疗单节段颈椎间盘突出症的疗效比较

目的:比较前路不同手术方式治疗单节段颈椎间盘突出症患者的临床疗效.方法:对2013年9月至2018年9月手术治疗的46例单节段颈椎间盘突出症患者临床资料进行回顾性分析,按不同的手术方法将患者分为3组,其中经皮前路椎间孔镜下颈椎间盘髓核摘除术(anterior percutanousendomic cervical di...